Development and validation of the Current Opioid Misuse Measure

Abstract

Clinicians recognize the importance of monitoring aberrant medication-related behaviors of chronic pain patients while being prescribed opioid therapy. The purpose of this study was to develop and validate the Current Opioid Misuse Measure (COMM) for those pain patients already on long-term opioid therapy. An initial pool of 177 items was developed with input from 26 pain management and addiction specialists. Concept mapping identified six primary concepts underlying medication misuse, which were used to develop an initial item pool. Twenty-two pain and addiction specialists rated the items on importance and relevance, resulting in selection of a 40-item alpha COMM. Final item selection was based on empirical evaluation of items with patients taking opioids for chronic, noncancer pain (N=227). One-week test-retest reliability was examined with 55 participants. All participants were administered the alpha version of the COMM, the Prescription Drug Use Questionnaire (PDUQ) interview, and submitted a urine sample for toxicology screening. Physician ratings of patient aberrant behaviors were also obtained. Of the 40 items, 17 items appeared to adequately measure aberrant behavior, demonstrating excellent internal consistency and test-retest reliability. Cutoff scores were examined using ROC curve analysis and reasonable sensitivity and specificity were established. To evaluate the COMM's ability to capture change in patient status, it was tested on a subset of patients (N = 86) that were followed and reassessed three months later. The COMM was found to have promise as a brief, self-report measure of current aberrant drug-related behavior. Further cross-validation and replication of these preliminary results is pending.

Changes in Pain Sensitivity and Pain Modulation During Oral Opioid Treatment: The Impact of Negative Affect

“…Other baseline measures included: the Neuroticism Subscale of the NEO Personality Inventory, the Pain Catastrophizing Scale [35], the Pain Anxiety Symptoms Scale [36], and the Beck Depression Inventory. In addition, subjects were evaluated for medication misuse with the Drug Misuse Index (DMI), which summarizes assessment of opioid misuse in 3 domains: patient self-report on the Current Opioid Misuse Measure [37], provider assessment of misuse on the Addiction Behaviors Checklist [38], and results of urine toxicology screening [39]. The DMI is converted to a categorical variable reflecting adherence to opioids; a positive finding of misuse on any of these three measures results in a positive DMI., If all three measures are negative for misuse, the DMI is negative [1,40].…”

Laboratory Testing for Prescription Opioids

“…Methods for detecting misuse are therefore critical adjuncts to prescribing these drugs. Several tools have been developed to aid in the detection opioid misuse and abuse including question-based screening tools [5][6][7][8][9], prescription drug monitoring programs [10], and drug testing. Urine drug testing (UDT) has been widely advocated as a method for identifying the misuse and abuse of opioid drugs during chronic pain and substance abuse treatment [11], and it is also frequently used in other clinical settings to screen for aberrant drug use such as in patients with behavioral disorders and other clinical signs and symptoms that suggest drug intoxication.…”

Treating Pain in Addicted Patients: Recommendations from an Expert Panel

“…28 Tools used for monitoring patients currently receiving prescription opioids include Pain Assessment and Documentation Tool, 29 and the Current Opioid Misuse Measure. 30 Selecting the most appropriate tool depends on the needs of the practice setting (brief versus comprehensive).…”